ACETYLSALICYLIC ACID (ASA)

TRADE NAME: Aspirin; St. Joseph’s; Bayer

SUMMARY:

Aspirin exhibits analgesic, anti-inflammatory, and antipyretic activity. The ability of aspirin to inhibit platelet aggregation is not exhibited by other salicylates currently available.  The exact mechanisms of analgesia and anti-inflammation have not been clearly established.  Aspirin inhibits the synthesis of prostaglandins in body tissues, which prevents the pain receptors from being sensitized to mechanical stimulation or to chemical mediators. Aspirin does not alter the pain threshold. Its analgesic effects appear to result from mainly a peripheral action, but the drug may also have similar activity and/or mechanisms of action in the CNS, possibly in the hypothalamus. In addition, the anti-inflammatory effect of aspirin may contribute to its analgesic effect. There is no evidence of tolerance or physical dependence with long-term therapy.  Because of its ability to inhibit platelet aggregation, aspirin is used for the prevention of thrombosis (particularly arterial thrombosis). Aspirin is not able to breakdown clots that have already formed; it can only help prevent future clots from occurring. At the prescribed dosages for prophylactic antithrombic therapy (162 to 325 mg/day), the prothrombin time (PTT) is not significantly elevated; however, the desired inhibition of platelet aggregation is achieved.

 

PHARMACOLOGICAL ACTION(S):

Analgesic

Anti-inflammatory

Anti-pyretic

Inhibits platelet aggregation (prolongs bleeding time)

 

SYSTEM INDICATION(S):

°          Chest Pain

°          Suspected Myocardial Event

°          Atrial Fibrillation/Flutter

°          CHF with suspected underlying causative cardiac event

 

CONTRAINDICATION(S):

·         Children with fever, recent illness

·         Decreased mental status

·         Hypersensitivity to ASA

·         History of allergic type reaction to NSAIDs (urticaria, angioedema, bronchospasm, severe rhinitis, shock)

·         Bleeding disorder effecting factor VII and IX

 

ACETYLSALICYLIC ACID (Cont’d)

PRECAUTION(S):

Alcohol intoxication

Decreased renal function

GI lesions (active or history of)

Hepatic disease

Hypoprothrombinemia

Juvenile arthritis

Lactation

Pregnancy

Rheumatic fever

Systemic lupus erythematosus (active)

Asthma

When administered to patients with varicella infections or influenza-like illnesses, there is an increased risk for developing Reye’s Syndrome

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Confusion, Dizziness, Drowsiness
EENT	Hearing loss, Tinnitus (toxicity)
GI	Anorexia, Diarrhea, GI bleeding, Heartburn, Nausea, Occult bleeding, Stomach pains, Vomiting, Ulcerations
Hemat	Hemolytic anemia, Thrombocytopenia (toxicity)
Derm	Easy bruising, Petechiae, Rash
Other	Anaphylactic shock, Bronchospasm, Impaired renal function, Laryngeal edema, Prolonged bleeding time, Prolonged pregnancy and labor with increased bleeding, Urticaria;

 

ROUTE OF ADMINISTRATION:

PO (within scope, preferred); PR

 

RATE OF ADMINISTRATION:

N/A

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
PO	5-30 min	1-3 hr	3-6 hr
PR	1-2 hr	4-5 hr	7 hr

 

REVERSAL TREATMENT(S):

These procedures are most effective up to 3-4 hours after acute ingestion, and may be effective for up to 10 hours after ingestion of massive doses.

Activated charcoal

Emesis/Ipecac

Gastric aspiration

Lavage

Supportive therapies

 

DOSE:

Adult:            162-324 mg PO, chewed and swallowed

Pedi:            Not Indicated

ADENOSINE

TRADE NAME: Adenocard, Adenoscan

SUMMARY:

Adenosine is an endogenous nucleoside, primarily formed from the breakdown product of adenosine triphosphate (ATP). Both of these compounds are found in every cell of the human body, and have a wide range of metabolic roles. Adenosine slows tachycardia associated with the AV node via modulation of the autonomic nervous system, without causing negative inotropic effects. Adenosine acts directly on sinus pacemaker cells and vagal nerve terminals to decrease chronotropic and dromotropic activity. Adenosine is recommended as the drug of choice for stable paroxysmal supraventricular tachycardia (PSVT). Adenosine depresses left ventricular function, but the effect is transient due to its short half-life.  Effective in 92% of those treated appropriately.

 

PHARMACOLOGICAL ACTION(S):

Antiarrhythmic properties

Coronary artery vasodilation

Restores sinus rhythm by interrupting A-V reentry pathways.

Slows conduction time through SA and AV nodes

 

SYSTEM INDICATION(S):

Stable SVT/PSVT

            Adult rate             >150

            5-10 y/o               >180

            1-5 y/o              >200

            Infant                >220

           

CONTRAINDICATION(S):

2^nd  or 3^rd  degree AV blocks

Sick sinus syndrome

Hypersensitivity to Adenosine or any or its components

 

PRECAUTION(S):

Asthma (may induce bronchospasm)

Carbamazepine may potentiate the AV-nodal blocking effect of Adenosine

Dipyramidole potentiates Adenosine (reduction of dose may be necessary)

Hepatic failure

Methylxanthines (caffeine and theophylline) antagonize the actions of Adenosine

Pregnancy

Renal failure

SVT induced by overdose / poisoning

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Headache, Irritability (in pediatrics), Lightheadedness, Paresthesia
CV	Asystole (transient), Atrial fibrillation, Atrial flutter, Hypotension, Palpitations, Sinus bradycardia (transient), Ventricular ectopy (transient)
GI	Metallic taste, Nausea
Resp	Dyspnea (transient), Shortness of breath
Derm	Diaphoresis, Facial flushing (transient)
Other	Chest pain.

 

ROUTE OF ADMINISTRATION:

Very Rapid IV Push

ADENOSINE (Cont’d)

RATE OF ADMINISTRATION:

Rapid IV bolus followed immediately with rapid fluid bolus of 20 mL in adults and 10 mL

in pediatrics

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	20-30 sec	Unknown	10 sec

 

REVERSAL TREATMENT(S):

N/A

 

DOSE:

Adult:            6mg, 12mg, 12mg, very rapid IV push with 20cc flush.  1-2 minutes between doses.  Max total dose 30mg.

Pedi:            0.1mg/kg, 0.2mg.kg, very rapid IV push with 3cc flush.  3-5 minutes between doses.  Max total dose 0.3mg/kg

ALBUTEROL SULFATE

TRADE NAME: Airet, Proventil, Salbutamol, Ventolin, Volmax

SUMMARY:

For patients with reversible airway obstruction, albuterol decreases resistance of the airways as measured by pulmonary function tests; the drug also increases vital capacity. Although the clinical importance has not been established, tolerance to the bronchodilating effects of albuterol has been reported in healthy  individuals and in asthmatics.  β2-adrenergic stimulation promotes an intracellular shift of potassium.  This makes albuterol potentially useful in treating conditions associated with hyperkalemia (e.g., renal failure).

 

PHARMACOLOGICAL ACTION(S):

Bronchodilation (beta-adrenergic agonist).  Albuterol stimulates β-adrenergic receptors and has little or no effect on alpha-adrenergic receptors. Albuterol appears to have a greater stimulating effect on the bronchial, uterine and vascular smooth muscles (β2-receptors) than on the heart (β1-receptors). The main effect of albuterol is bronchodilation resulting from relaxation of the smooth muscles of the bronchial tree; the drug also has some vasodilating effect on the peripheral vasculature and may decrease diastolic blood pressure to a small extent.  Albuterol may cause reflex tachycardia, especially with higher than usual doses.

 

SYSTEM INDICATION(S):

Asthma

Bronchospasm

Congestive Heart Failure/Dyspnea of Uncertain Etiology

COPD

Hyperkalemia

Hyperkalemic Arrest

 

CONTRAINDICATION(S):

Hypersensitivity to adrenergic amines

Hypersensitivity to fluorocarbons (Inhalers only)

 

PRECAUTION(S):

Cardiac disease/Coronary Arterial Disease

Diabetes mellitus

Diuretic induced hypokalemia (may be potentiated)

Glaucoma

Hypertension

Hyperthyroidism

Prostatic hypertrophy

Seizure disorders

Tachycardia

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Headache, Insomnia, Nervousness, Restlessness, Tremors
CV	Angina, Dysrythmia, Hypertension
GI	Nausea, Vomiting
ENDO	Hyperglycemia.

ALBUTEROL SULFATE (Cont’d)

ROUTES OF ADMINISTRATION:

Nebulized Inhalation

ETT (Hyperkalemic Arrest)

 

RATE OF ADMINISTRATION:

Continuous nebulization, titrated to relief of Bronchospasm.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
Inhalation	5-15 min	60-90 min	3-6 hr
PO	15-30	min 2-3 hr	~8 hr

 

REVERSAL TREATMENT(S):

Only when necessary should a relatively selective β-1 adrenergic blocking agent, such as metoprolol tartrate, be used to treat an albuterol overdose. Use extreme caution in patients with asthma, due to possible initiation of an asthma attack by such agents.

 

DOSE:

Adult:            Continuous nebulization with Ipratropium Bromide 1:1 to relief of bronchospasm.

Pedi:            Continuous nebulization with Ipratropium Bromide 1:1 to relief of bronchospasm.

 

AMIODARONE HYDROCHLORIDE

TRADE NAME: Cordarone

 

SUMMARY:

Amiodarone is an antiarrhythmic agent possessing several antiarrhythmic effects that result in a decreased number of VT/VF events. It prolongs the duration of action potentials in cardiac fibers, depresses conduction velocity, slows conduction at the AV node, and exhibits some alpha and beta blockage activity. Also has vasodilatory effects that decrease cardiac workload and myocardial oxygen consumption. Uptake by the myocardium is rapid; antiarrhythmic effect is prompt; however, full effect may take days. Has an exceptionally long half-life.

 

PHARMACOLOGICAL ACTION(S):

Prolongs action potential and refractory period in myocardial tissue

Inhibits adrenergic stimulation

Slows the sinus rate, increases P-R and Q-T intervals, and decreases peripheral vascular resistance

Suppression of arrhythmias

 

SYSTEM INDICATION(S):

Ventricular Tachycardia/Ventricular Fibrillation

Dysrhythmia with rate >150 or imminent instability and history of WPW or LGL

 

CONTRAINDICATION(S):

Known hypersensitivity to Amiodarone, or any of its components

Severe sinus node dysfunction (including Sinus Bradycardia)

2^nd  and 3^rd  degree AV block

Neonates

 

PRECAUTION(S):

History of congestive heart failure

Thyroid disorder

Severe pulmonary or liver disease

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Dizziness, fatigue, malaise
EENT	Corneal microdeposits
Resp	ARDS
CV	Bradycardia, hypotension
GI	Constipation, Nausea, Vomiting
Derm	Photosensitivity
Endo	Hypothyroidism
Neuro	Ataxia, tremor, involuntary movement, poor coordination, peripheral neuropathy, paresthesia

 

ROUTE OF ADMINISTRATION:

IV (or IO in Pediatric)

 

 

 

AMIODARONE HYDROCHLORIDE (Cont’d)

RATE OF ADMINISTRATION:

Infusion in non-arrest settings

Bolus in arrest settings

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	1 4 min	unknown	unknown

 

REVERSAL TREATMENT(S):

Supportive measures.

 

DOSE:

NON ARREST

Adult:            Loading:  150mg in 50ml over 10 minutes (repeat once only if refractory).

            Infusion:  1mg/min

Pedi:            Loading:  5mg/kg in 50ml over 5-60 minutes. (Shorter dose decreases chance of leaching of plasticiser from IV bag and tubing)

           

ARREST

Adult:            300mg bolus, as soon as possible after first epinephrine dose (or Vasopressin dose).

Pedi:            5 mg/kg IV or IO as soon as possible after first epinephrine dose (or Vasopressin dose).

 

ATROPINE SULFATE

TRADE NAME: Atropair, Atropen, Atropisol, 1-tropine, Ocu-Tropine

 

SUMMARY:

Atropine sulfate, a potent parasympatholytic, inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites.  Small doses of atropine inhibit salivary and bronchial secretions, while moderate doses dilate pupils and increase heart rate. Large doses of atropine decrease gastrointestinal motility, inhibit gastric acid secretion, and may block nicotinic receptor sites at the autonomic ganglia and at the neuromuscular junction. Atropine blocks vagal effects, resulting in positive chronotropy and positive dromotropy, with limited or no inotropic effect. In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardia.

 

Atropine will not have an effect on respiratory depression associated with organophosphate poisoning.  Aggressive airway management in indicated for these patients.

 

PHARMACOLOGICAL ACTION(S):

Anticholinergic

Antidysrrhythmic

Antimuscarinic

Mydriatic

 

SYSTEM INDICATION(S):

            EMS:

°          Asystole/Bradycardic PEA

°          Organophosphate toxicity

°          Rapid Sequence Induction (pediatric)

°          Sinus bradycardia with 1^st  degree or 2^nd degree (Winkebach)  AV block

 

CONTRAINDICATION(S):

Acute hemorrhage

Glaucoma (narrow angle)

Hepatic disease

Hypersensitivity

Myasthenia gravis

Severe ulcerative colitis and toxic megacolon

Tachycardia secondary to cardiac insufficiency

Thyrotoxicosis

ATROPINE (Cont’d)

PRECAUTION(S):

Cardiac disease (chronic)

Geriatrics

Hepatic disease (chronic)

Intra-abdominal infections

Lactation

Pediatrics

Pregnancy

Prostatic hypertrophy

Pulmonary disease (chronic)

Renal disease (chronic)

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Confusion, Drowsiness
EENT	Blurred vision, Cycloplegia, Dry eyes, Mydriasis
CV	Palpitations, Tachycardia
GI	Constipation, Dry mouth
GU	Urinary hesitancy
Misc	Decreased sweating

 

ROUTE OF ADMINISTRATION:

IM (1:1000)

IV (1:10,000)

 

RATE OF ADMINISTRATION:

Rapid push.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	< 1 min	15-30 min	4-6 hr
IV	< 1 min	2-4 min	4-6 hr

 

REVERSAL TREATMENT(S):

Symptomatic and supportive therapies

If medication was taken orally, use suction, lavage, emesis and/or charcoal

Treat symptoms and reactions as they occur and as necessary

DOSE:

Cardiac-Symptomatic Bradycardia

Adult:            0.5-1mg q 5 minutes to max 0.04mg/kg

Pedi:            0.02mg/kg q 5 minutes to max 0.04mg/kg.  Minimum 0.5mg in children and 1mg in young adults

Cardiac-Asystole, Bradycardic PEA

Adult:            1mg q 3 minutes to max 0.04mg/kg

Pedi:            0.02mg/kg q 5 minutes to max 0.04mg/kg.  Minimum 0.5mg in children and 1mg in young adults

Organophosphate Poisoning

Adult:            2-6mg q 5 minutes to evidence of atropinization.

Pedi:            0.05mg q 5-10 minutes to evidence of atropinization.

 

CALCIUM CHLORIDE

TRADE NAME: N/A

SUMMARY:

Calcium is essential for nervous, muscular, and skeletal systems.  It stabilizes cell membrane structure and enhances capillary permeability.  Promotes transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.  Essential for bone formation and blood coagulation.  CaCl is necrotic and should be administered extremely slowly to prevent damage to vessels.  It is advisable to prepare a solution for infusion over the time indicated by mixing the appropriate dose of the available stock supply into 50 ml saline.

 

PHARMACOLOGICAL ACTION(S):

Electrolyte replenishment

Anti-hypocalcemic

Cardiotonic

Anti-hyperkalemic

Anti-hypermagnesemic

 

SYSTEM INDICATION(S):

Hypocalcemic disorders.

Hyperkalemia related cardiac dysrhythmia

OLMC:  Relief of muscle cramping associated with insect bites or stings

OLMC:  Relief of acute symptoms associated with lead colic, rickets, or osteomalacia.

Toxicity:

Hydrofluoric acid exposure

Calcium channel blocker overdose (symptomatic)

Magnesium sulfate overdose (symptomatic)

 

CONTRAINDICATION(S):

Hypercalcemia

Ventricular fibrillation / ventricular tachycardia

 

PRECAUTION(S):

Patients receiving digitalis

Renal disease

Severe respiratory insufficiency/Respiratory failure

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Tingling, Syncope
CV	Bradycardia, arrhythmias, hypotension
GI	Nausea, Vomiting, Constipation
GU	Hypercalcuria, Calculi
Misc	Burning sensation at IV site, Metallic, calcium or chalky taste

 

 

CALCIUM CHLORIDE (Cont’d)

ROUTE OF ADMINISTRATION:

IV

Transdermal

 

RATE OF ADMINISTRATION:

IV Infusion;

Stop or slow rate if patient complains of discomfort.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	< 1 min	< 1 min	½ - 2 hrs
PO	unknown	unknown	unknown

 

REVERSAL TREATMENT(S):

Stop infusion

Symptomatic and supportive therapies

Treat symptoms and reactions as they occur and as necessary.

 

DOSE:

(Calcium Channel Blocker Overdose)

Adult:            1-2g IV over 5 minutes repeated once, 10 minutes after original dose. OLMC for additional.

Pedi:            20mg/kg IV or IO over 10 minutes.  OLMC for repeat doses.

(Hyperkalemia with Indicative ECG Changes/Hyperkalemic Arrest)

Adult:            1-2g IV over 5 minutes with 2-3 minute saline flush before administration of NaHCO₃

Pedi:            OLMC

(Magnesium Sulfate Overdose)

Adult:            1-2g IV over 5 minutes repeated once, 10 minutes after original dose. OLMC for additional.

Pedi:            OLMC

DEXTROSE

TRADE NAME: D10, D25, D50

SUMMARY:

The term dextrose is used to describe the six-carbon sugar d-glucose, the main form of carbohydrate utilized by the body.  Ten percent is used to treat hypoglycemia in newborns (< 1 month old).  Twenty-five percent dextrose is used in emergency care to treat hypoglycemia in young pediatric patients (one month to one year old).  Fifty percent dextrose is used to treat patients older than one year old.  Dextrose is necrotic and should be diluted in extremely young and old patient populations

 

PHARMACOLOGICAL ACTION(S):

Provides glucose calories for metabolic needs.

Metabolized to form carbon dioxide and water.

Its exudation provides water to sustain volume and may help lower excessive ketone production and prevent protein loss.

Readily excreted by the kidneys, promoting diuresis.

 

SYSTEM INDICATION(S):

Hypoglycemia   (D10 and D25 are intended for pediatric use)

 

CONTRAINDICATION(S):

Allergy to corn or corn products

 

PRECAUTION(S):

Bleeding disorders

Chronic alcoholism

Malnourished patients

Marked hemostatic disorders

Severe kidney damage

Thrombocytopenia

Anuria

CNS bleeding

Delirium tremens with dehydration

Glucose-galactose malabsorption syndrome

Hyperglycemia

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

Endo	Inappropriate insulin secretion (long term use)
F&E	Fluid overload, Hypokalemia, Hypomagnesemia, Hypophosphatemia
Local	Pain and irritation at IV site
Metab	Glycosuria, Hyperglycemia

 

ROUTE OF ADMINISTRATION:

IV (large bore preferable) or IO (children)

Administer IM Glucagon if IV access is not obtainable.

DEXTROSE (Cont’d)

RATE OF ADMINISTRATION:

Slow IV

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	< 1 min	< 1 min	variable

 

REVERSAL TREATMENT(S):

None, prehospitally.

 

DOSE:

Adult:                                    25g D50, repeat prn.

Pedi >1 year old:            25g D50, repeat prn.

Infant 1 mo-1 year old:            0.5 - 1g/kg D25, repeat prn.

Infant                                    0.5 – 1g/kg D10, repeat prn.

DIAZEPAM

TRADE NAME: Diastat, Dizac, D-Val, Valium, Valrelease, Zetram

SUMMARY:

Diazepam, a benzodiazapine, is a frequently prescribed medication used to treat anxiety and stress. In emergency care, it is used to treat substance withdrawal, stimulant overdose, and convulsive  seizure activity.  Diazepam acts on the limbic, thalamic, and hypothalamic regions of the CNS to potentiate the effects of inhibitory neurotransmitters, thus raising the seizure threshold in the motor cortex. It may also be used in conscious patients during cardioversion and transcutaneous pacing to induce amnesia and sedation. Although the drug is still widely used as an anticonvulsant, its short duration limits its use.  Rapid IV administration may be followed by respiratory depression and excessive sedation.

 

PHARMACOLOGICAL ACTION(S):

Depresses CNS, ANS, PNS in unknown manner

Exerts antianxiety, sedative/hypnotic, amnesic, anticonvulsant, skeletal muscle relaxant, and anti-tremor effects

Metabolized in the liver

Crosses placental barrier

Secreted in breast milk

 

SYSTEM INDICATION(S):

Convulsions

Severe Muscle Spasm (Medical or Traumatic)

Stimulant Overdose

 

CONTRAINDICATION(S):

CNS depression

Coma

Decreased blood pressure, heart rate or respiratory rate

Hypersensitivity

 

PRECAUTION(S):

• Consider reducing dosage by half in a patient with:

o Debilitation

o Geriatrics

o Hepatic dysfunction

o Petit mal seizures

o Presence of other CNS depressants

o Renal impairment

• Glaucoma (narrow angle)

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Depression, Dizziness, Drowsiness, Hangover, Headache, Lethargy, Paradoxical excitation
EENT	Blurred vision
Resp	Depression
CV	Hypotension (IV only)
GI	Constipation, Diarrhea, Nausea, Vomiting
Derm	Rash
Local	Pain at IM site, Phlebitis at IV site, Venous thrombosis
Misc	Physical dependence, Psychological dependence, Tolerance

 

DIAZEPAM (Cont’d)

ROUTE OF ADMINISTRATION:

IM

IV (preferred)

PR (preferred)

 

RATE OF ADMINISTRATION:

IV Adult not to exceed 5 mg/minute

IV Pedi not to exceed 1 mg/minute

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	< 20 min	0.5-1.5 hr	unknown
IV	1-5 min	15-30 min	15-60 min
PR	varied	1-2 hr	4-12 hr

 

REVERSAL TREATMENT(S):

Supportive measures

Antidote:  Flumazenil (Romazicon) titrated for respiratory status.

 

DOSE:

Convulsions

Adult:            IV 5-10mg q 5-10 minutes to cessation of convulsion

Pedi:            IV  0.1-0.2mg/kg to max 5mg dose q 5-10 minutes

            PR 0.5mg/kg to max 10mg dose.  May repeat q 10-15 at 0.25mg/kg

 

Severe Muscle Spasm (medical or traumatic)

Adult:            IV 2.5-5mg.  OLMC for additional doses.

Pedi:            Not indicated.

 

Stimulant Overdose

Adult:            5-10mg, repeated one time after 5-10 minutes following first dose.

Pedi:            OLMC IV  0.1-0.2mg/kg to max 5mg dose q 5-10 minutes

            OLMC PR 0.5mg/kg to max 10mg dose.  May repeat q 10-15 at 0.25mg/kg

DILTIAZEM HYDROCHLORIDE

TRADE NAME: Cardizem

SUMMARY:

Effective in Supraventricular tachydysrhythmias because it slows conduction through the AV node, prolongs the effective refractory period, reduces ventricular rates, and helps to prevent embolic complications.  Prevents reentry phenomena through the AV node.  Reduces heart rate, systolic and diastolic blood pressure, systemic vascular resistance, pulmonary artery systolic and diastolic blood pressures, and coronary vascular resistance with no significant effect on contractility, left ventricular end diastolic pressure, right atrial pressure, or pulmonary capillary wedge pressure.  Increases cardiac output and stroke volume.  Has little or no effect on normal AV nodal conduction at normal heart rates.

 

PHARMACOLOGICAL ACTION(S):

Calcium channel blocker.  Directly inhibits the influx of calcium ions through slow channels during membrane depolarization of cardiac and vascular smooth muscle. 

 

SYSTEM INDICATION(S):

Atrial fibrillation or atrial flutter with RVR (>150).

SVT/PSVT not responsive to adenosine (Adenocard)

 

CONTRAINDICATION(S):

RVR associated with an accessory bypass tract (e.g., WPW, LGL, or short PR syndromes)

Cardiogenic shock

CHF not secondary to supraventricular tachyarrhythmia

Known sensitivity to Diltiazem

2^nd  or 3^rd  degree AV block or sick sinus syndrome

Profound hypotension

Patients receiving IV beta-blockers within 2 hours

Wide complex tachydysrhythmias of unknown origin

 

PRECAUTION(S):

Severe hepatic impairment

Severe renal impairment

History of serious ventricular arrhythmias or CHF

Lactation

Pediatrics

Pregnancy

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Dizziness, psychiatric disturbances, headache, weakness, shakiness, anxiety, drowsiness, confusion, abnormal dreams
EENT	Blurred vision, tinnitus, disturbed equilibrium
Resp	Dyspnea, cough, congestion
CV	Peripheral edema, CHF, palpitations, hypotension, syncope, arrhythmias, bradycardia, tachycardia, chest pain
GU	Polyuria, dysuria, urinary frequency
GI	Nausea, Vomiting, Diarrhea
Derm	Rash, urticaria, increased seething
MS	Muscle cramps, joint stiffness
Neuro	Paresthesia, tremor

 

DILTIAZEM HYDROCHLORIDE (Cont’d)

ROUTE OF ADMINISTRATION:

IV

 

RATE OF ADMINISTRATION:

2 minutes

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	2-5 min	unknown	unknown
PO	30 minutes	2-3 hrs	6-8 hrs

 

REVERSAL TREATMENT(S):

D/C infusion

Calcium chloride (see Calcium Chloride)

Supportive measures

 

DOSE:

Adult:            IV 0.25mg/kg to max first dose of 20mg. 

Repeat in 15 minutes at 0.35mg/kg to max of 25mg.

Pedi:            NOT INDICATED

DIPHENHYDRAMINE HYDROCHLORIDE

TRADE NAME: Benadryl

SUMMARY:

Diphenhydramine, an antihistamine, prevents the physiologic actions of histamine by preventing histamines from reaching H₁ receptor site. The benefits of antihistamines are short-lived, and provide only symptomatic relief. Antihistamines are specific for conditions in which histamine excess is present (e.g., acute urticaria), but are adjunctive therapy in the treatment of anaphylactic shock since epinephrine is more effective. Antihistamines are also specific for reversing extrapyramidal reactions, and are probably efficacious as drying agents in upper respiratory and sinus conditions.

 

PHARMACOLOGICAL ACTION(S):

Anticholinergic

Antiemetic

Antihistamine

CNS depressant

Relief of acute dystonic reactions

Suppression of cough

 

SYSTEM INDICATION(S):

Allergic reaction

Anaphylaxis (supplement after Epi)

Extrapyramidal (dystonic) side effects of medications

Severe nausea in presence of sensitivity to Promethazine

Parkinson’s syndrome associated dystonia (OLMC)

Vomiting

 

CONTRAINDICATION(S):

Acute asthma

Hypersensitivity

 

PRECAUTION(S):

Alcohol ingestion

Lactation

Geriatrics

Glaucoma (narrow angle)

OD may cause convulsions and death in pediatrics

Peptic ulcer

Pregnancy

Prostatic hypertrophy

Seizure disorders

Severe liver disease

DIPHENHYDRAMINE HYDROCHLORIDE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Dizziness, Drowsiness, Headache, Paradoxical excitation
EENT	Blurred vision, Tinnitus
CV	Hypotension, Palpitations
GI	Anorexia, Constipation, Diarrhea, Dry mouth
GU	Dysuria, Frequency, Urinary retention
Derm	Photosensitivity
Local	Pain at IM site

 

ROUTE OF ADMINISTRATION:

IM

IV

 

RATE OF ADMINISTRATION:

25 mg/minute

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	20-30 min	1-4 hr	4-8 hr
IV	< 1 min	unknown	4-8 hr

 

REVERSAL TREATMENT(S):

NONE

 

DOSE:

Allergic Reaction/Anaphylaxis

Adult:            25-50mg to severity.  Max 50mg

Pedi:            1mg/kg to max total dose 50mg

 

Acute Dystonic Reaction

Adult:            25mg q 10 minutes to max total dose 50mg

Pedi:            1mg/kg to max total dose 50mg

DOPAMINE HYDROCHLORIDE

TRADE NAME: Dopastat, Intropin, Revimine

SUMMARY:

Dopamine is chemically related to norepinephrine.  It acts primarily on α1- and β1-adrenergic receptors in a dose-dependent fashion.  At low doses (“renal doses”), dopamine has a dopaminergic effect that causes renal, mesenteric and cerebral vascular dilation. At moderate doses (“cardiac doses”), dopamine has β1- and α-adrenergic effects, causing enhanced myocardial contractility, increased cardiac output, and a rise in blood pressure.  At high doses (“vasopressor doses”), dopamine has an α-adrenergic effect, producing peripheral arterial and venous constriction. Dopamine is commonly used in the treatment of hypotension associated with cardiogenic shock.

PHARMACOLOGICAL ACTION(S):

Low dose (0.5-2 mcg/kg/minute) Dopaminergic effects

Medium dose (2-10 mcg/kg/minute) Dopaminergic & β1 effects

High dose (10-20 mcg/kg/minute) β1 & α effects

Extreme dose (> 20 mcg/kg/minute) Pure α effects (NorEpi)

Alpha

·         Increases peripheral vasoconstriction

Beta 1

·         Increases automaticity

·         Increases chronotropic & inotropic actions

·         Increases myocardial workload and oxygen demand

Beta 2

·         Bronchial smooth muscle relaxation

·         Dilation of skeletal muscle vasculature

Dopaminergic

·         Vasodilation of renal, mesenteric, and cerebral arteries

·         Promotes urine production

 

SYSTEM INDICATION(S):

Cardiogenic shock

Hypotension secondary to myocardial infarction

Renal failure

Sepsis

Hypotension not responsive to fluid therapy, positioning, other therapy

 

CONTRAINDICATION(S):

Pheochromocytoma

Uncorrected tachydysrhythmias including ventricular fibrillation

 

PRECAUTION(S):

Lactation

Monoamine oxidase inhibitors reduce dopamine dosage to 10% of usual dose

Occlusive vascular disease

Pediatrics

Pregnancy

DOPAMINE HYDROCHLORIDE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Headache
EENT	Mydriasis (high doses)
Resp	Dyspnea
CV	Angina, Dysrhythmias, ECG changes, Hypertension, Palpitations, Vasoconstriction
GI	Nausea, Vomiting
Derm	Piloerection
Local	Irritation at IV site

 

ROUTE OF ADMINISTRATION:

IV Infusion

 

RATE OF ADMINISTRATION:

Titrate drug to effect (desired systolic/perfusion pressure)

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV INF	5 min	< 1 min	< 10 min

 

REVERSAL TREATMENT(S):

D/C infusion (effects are short lived due to short half-life & duration of action)

Supportive measures.

 

DOSE:

Adult:            5-20mcg/kg/minute to severity.

Pedi:            2-20mcg/kg/minute to severity.

EPINEPHRINE (EPI)

TRADE NAME: Adrenalin, Epi-Pen, Epi-Pen Jr.

SUMMARY:

Epinephrine stimulates α, β1-, and β2-adrenergic receptors in dose-related fashion. It is the initial drug of choice for treating bronchoconstriction and hypotension resulting from anaphylaxis, as well as all forms of cardiac arrest. It is useful in management of reactive airway disease.  β-adrenergic agents are often used initially due to the convenience and availability of the oral inhalation route. Rapid injection produces a rapid increase in blood pressure, ventricular contractility, and heart rate. In addition, epinephrine causes vasoconstriction in the arterioles of the skin, mucosa, and splanchnic areas, and antagonizes the effects of histamine.

PHARMACOLOGICAL ACTION(S):

α

·         Increases peripheral vasoconstriction

β1

·         Increases automaticity

·         Increases chronotropic actions

·         Increases inotropic actions

·         Increases myocardial workload and oxygen demand

β2

·         Bronchial smooth muscle relaxation

·         Dilation of skeletal muscle vasculature

SYSTEM INDICATION(S):

Anaphylaxis/allergic reactions

Cardiac arrest:  Asystole, PEA, V Fib, Pulseless V Tach

Asthma

 

CONTRAINDICATION(S):

None in anaphylaxis, cardiac arrest, or status asthmaticus

 

PRECAUTION(S):

Cardiac disease

Diabetes

Digitalis (high doses)

Geriatrics

Glaucoma

Hypertension

Hyperthyroidism

Lactation

Monoamine oxidase (MAO) inhibitors concomitant use may cause hypertension

Pregnancy

Stimulant overdose

 

EPINEPHRINE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Headache, Insomnia, Nervousness, Restlessness, Tremors
Resp	Paradoxical bronchospasm (excessive inhalers)
CV	Angina, Dysrhythmias, Hypertension, Tachycardia
GI	Nausea, Vomiting
Endo	Hyperglycemia

 

ROUTE OF ADMINISTRATION:

DEPENDS ON CONDITON

ETT (1:1000)

IM  (1:1000)

Inhaled (1:1000)

IV Slow Push (1:10,000)

IV Infusion (1:100,000; 1mg 1:1000 in 50ml)

 

RATE OF ADMINISTRATION:

Variable, depending on condition, treatment goals.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	6-12 min	unknown	< 1-4 hr
Inhaled/ETT	3-5 min	unknown	1-3 hr
IV	< 1 min	20 min	20-30 min

 

REVERSAL TREATMENT(S):

Supportive measures.

 

DOSE:

Allergic Reaction/Anaphylaxis

Adult:            IM 0.3-0.5mg q 10-20 minutes. 

IV 0.1-0.2mg one dose.  Infuse 2.5-15mcg/min.

Pedi:            IM  0.01mg/kg to max single dose 0.3mg, q 10-20 minutes, prn

            IV  (<30kg)  5mcg/kg, q 10-20 minutes, prn (extremis)

 

Bradycardia (Symptomatic)

Adult:            Not Indicated for Adult Bradycardia

Pedi:            IV/IO 0.01mg/kg q 3-5 minutes

            ETT 0.1mg/kg with 2-3 ml flush

 

Cardiac Arrest:  Asystole, PEA, V Fib, Pulseless V Tach

Adult:            1mg q 3 minutes

Pedi:            IV/IO  0.01mg/kg q 3-5 minutes

            ETT  0.1mg/kg with 2-3 ml flush q 3-5 minutes

 

Asthma

Adult:            Not Indicated for Adult Asthma

Pedi:            IM 0.01mg/kg to max single dose 0.3mg q 10-20 minutes, prn.

 

 

 

FUROSEMIDE

TRADE NAME: Lasix

SUMMARY:

Furosemide is a rapid-acting, potent “loop” diuretic that inhibits the reabsorption of sodium and chloride primarily in the Loop of Henle and also in the proximal and distal tubules.  An exact mode of action is not clearly defined.  Renal vascular resistance decreases, and renal blood flow may increase during drug administration.  Furosemide is somewhat ototoxic, particularly when administered rapidly.  Furosemide is used in the treatment of edema associated with CHF, cirrhosis of the liver, and renal disease, including nephrotic syndrome. Furosemide may be used for the management of hypertension, alone or in combination with other antihypertensive agents, and for the treatment of hypercalcemia. Furosemide has been used concomitantly with mannitol for the treatment of severe cerebral edema, particularly in meningitis.

 

PHARMACOLOGICAL ACTION(S):

Increases excretion of H₂O, Na⁺, Cl^-, Mg²⁺, H⁺, K⁺, & Ca⁺

Potent rapid diuretic

Decreases preload by venous pooling

Vasodilation decreases afterload

 

SYSTEM INDICATION(S):

CHF

S/P Hyperkaemic Arrest

 

CONTRAINDICATION(S):

Anuria

Cross sensitivity with thiazides and sulfonamides

Hepatic

Hypersensitivity

Hypotension

Pre-existing uncorrected electrolyte imbalance

FUROSEMIDE (Cont’d)

PRECAUTION(S):

Corticosteroids (may increase risk of gastric hemorrhage)

Diabetes

Electrolyte depletion

Geriatrics

Lactation

Lupus erythematosus (may be activated or exacerbated)

Pediatrics

Pregnancy

Severe liver disease with ascites/cirrhosis

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Dizziness, Encephalopathy, Headache, Insomnia, Nervousness
EENT	Hearing loss, Tinnitus
CV	Hypotension
GI	Constipation, Diarrhea, Dry mouth, Dyspepsia, Nausea, Vomiting
GU	Excessive urination
Derm	Photosensitivity, Rash
Endo	Hyperglycemia
F&E	Dehydration, Hypochloremia, Hypokalemia, Hypomagnesemia, Hyponatremia, Hypovolemia, Metabolic alkalosis
Hemat	Blood dyscrasias
Metab	Hyperglycemia, Hyperuricemia
MS	Arthralgia, Muscle cramps, Myalgia
Misc	Increased BUN

 

 

ROUTE OF ADMINISTRATION:

IV

 

RATE OF ADMINISTRATION:

Very slow IV push due to ototoxic properties

 

TIME / ACTION PROFILE:

 

REVERSAL TREATMENT(S):

Supportive measures

 

DOSE:

Adult:      0.5-1mg/kg or twice daily dose to max 120mg with SBP >100.

Pedi:      Not Indicated.

GLUCAGON HYDROCHLORIDE

SUMMARY:

A pancreatic polypeptide hormone from the α cells of the islets of Langerhans.  Blood glucose is raised by activating phosphorylase, which converts glycogen to glucose in the liver.  Glucagon acts only on liver glycogen.  Produces relaxation of the smooth muscle of the  stomach, duodenum, small bowel and colon.

 

PHARMACOLOGICAL ACTION(S):

Stimulates hepatic production of glucose from glycogen stores (glycogenolysis) Relaxes the musculature of the GI tract

Has positive inotropic and chronotropic effects

 

SYSTEM INDICATION(S):

Hypoglycemia

Beta-blocker overdose

Calcium channel blocker overdose

 

CONTRAINDICATION(S):

Hypersensitivity to medication

 

PRECAUTION(S):

History of insulinoma or pheochromocytoma

Nausea and vomiting common after administration, particularly with larger doses

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

GI	Nausea, vomiting
CV	Tachycardia, hypertension, hypotension

 

 

ROUTE OF ADMINISTRATION:

IM

IV

 

RATE OF ADMINISTRATION:

Dose over 1 minute

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV/IM	5-20 min	30 min	1-2 hrs

 

REVERSAL TREATMENT:

Antiemetics for nausea and/or vomiting

For any other side effects, discontinue and notify the receiving facility. 

Insulin administration may be indicated in acute overdose.

 

DOSE:

Adult:    1 unit dose (1mg)

Pedi:     0.1mg/kg to single dose 1mg

IPRATROPIUM BROMIDE

TRADE NAME: Atrovent

SUMMARY:

Ipratropium is chemically related to atropine.  It has a low solubility and does not cross the blood-brain barrier.  Ipratropium produces local, site-specific effects on the larger central airways.  Bronchodilation inhibits acetylcholine at its receptor sites, thereby blocking cholinergic bronchomotor tone (bronchoconstriction).  It also abolishes vagally mediated reflex bronchospasm triggered by such non-specific agents as cigarette smoke, inert dusts, cold air, and a range of inflammatory mediators (e.g., histamine).  Ipratropium is also used in maintenance therapy of COPD, including chronic bronchitis and emphysema.

 

PHARMACOLOGICAL ACTION(S):

Inhibits cholinergic receptors in bronchial smooth muscle, resulting in a decreased concentration of cyclic guanosine monophosphate (cGAMP)

Decreased levels of cGAMP produce local bronchodilation

 

SYSTEM INDICATION(S):

Acute decompensating reactive airway disease

Bronchodilator in maintenance therapy of reversible airway obstruction due to reactive airway disease

Severe systemic anaphylaxis

 

CONTRAINDICATION(S):

Hypersensitivity to:

o Atropine

o Belladonna alkaloids

o Bromide

o Fluorocarbons

o Ipratropium

 

PRECAUTION(S):

Bladder neck obstruction

Geriatrics (more sensitive to effects)

Glaucoma

Lactation

Pregnancy

Prostatic hypertrophy

Urinary retention

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Dizziness, Headache, Nervousness
EENT	Blurred vision, Sore throat
Resp	Bronchospasm, Cough
CV	Hypotension, Palpitations
GI	Nausea
Derm	Rash.

IPRATROPIUM BROMIDE Cont

ROUTE OF ADMINISTRATION:

Inhalation via nebulizer, with/after beta agonist inhalation/nebulization

 

RATE OF ADMINISTRATION:

Nebulized with 100% oxygen at 6 LPM

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
Inhalation	5-15 min	1-2 hr	3-6 hr

 

 

REVERSAL TREATMENT(S):

Supportive measures.

 

DOSE:

Adult:            With Albuterol, nebulized 1:1 continuously to relief of symptoms

Pedi:            With Albuterol, nebulized 1:1 continuously to relief of symptoms

 

LIDOCAINE HYDROCHLORIDE

TRADE NAME: Nervocaine, Octocaine, Xylocaine, Lidocaine gel

SUMMARY:

Lidocaine has cardiac actions similar to those of procainamide and quinidine. Lidocaine; however, has little effect on myocardial contractility, AV and intraventricular conduction, cardiac output, and systolic arterial pressure in equivalent doses.  Lidocaine exerts anti-arrhythmic action (class 1b) by suppressing automaticity in the His-Purkinje system and by elevating the electrical stimulation threshold of the ventricle during diastole. Progressive depression of CNS occurs with increasing blood concentrations; this produces anticonvulsant, sedative, and analgesic effects.  Lidocaine’s action as a local anesthetic is more prompt, more intense, and longer lasting than that of procaine.  Lidocaine also suppresses cough and gag reflexes.  Lidocaine decreases phase 4 diastolic depolarization, and has been shown to be effective in suppressing premature ventricular contractions. In addition, it is used to treat ventricular tachycardia and cases of ventricular fibrillation.  Lidocaine also raises the fibrillation threshold.

 

PHARMACOLOGICAL ACTION(S):

Suppresses automaticity of conduction tissue and spontaneous depolarization of the ventricles during diastole, by altering flux of sodium ions across cell membranes (Na Channel blockade).  It has little to no effect on heart rate in normal conduction systems.

 

SYSTEM INDICATION(S):

Control of ICP before Succinylcholine in Rapid Sequence Induction

Post conversion prophylaxis with conversion after Lidocaine administration

Ventricular fibrillation

Ventricular tachycardia

 

CONTRAINDICATION(S):

Due to the fact that this drug is an amide and not an ester, patients with a Lidocaine (amide) allergy should not have a cross-sensitivity with either cocaine or Novocain (both esters).

Hypersensitivity to –caine medications

Ideoventricular rhythm

2^nd  or 3^rd  degree heart block without a functioning implanted pacemaker in place

Sinus bradycardia

Wolff-Parkinson-White syndrome

LIDOCAINE HYDROCHLORIDE (Cont’d)

PRECAUTION(S):

Congestive heart failure

Geriatrics > 70 years of age (reduce infusion by half)

Hepatic disease

Lactation

Patient weighs < 50 kg (< 110 lbs.)

Pregnancy

More than one precursor to complete A-V block

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Confusion, Dizziness, Drowsiness, Lethargy, Nervousness, Seizures, Tremors
CV	Dysrhythmias, Bradycardia, Cardiac arrest, Hypotension
GI	Nausea, Vomiting
Derm	Burning, Erythema, and Stinging at IV site

 

 

ROUTE OF ADMINISTRATION:

ET

IV

IV Infusion

Topical

 

RATE OF ADMINISTRATION:

Bolus: 25-50 mg over 1 minute, except in arrest situations

o [Too rapid injection can cause seizures]

Infusion: Use 60 gtts/mL IV tubing for delivery

o Adjust rate as indicated by patient’s condition/progress

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	< 1 min	< 1 min	10-20 min
Topical	< 1 min	Unknown	1 –3 hrs

 

REVERSAL TREATMENT(S):

Supportive measures

 

DOSE:

Adult:            IV 1-1.5mg/kg q 10 minutes to max of 3mg/kg

            INF 1mg/minute

Pedi:            IV 1-1.5mg/kg q 10 minutes to max of 3mg/kg

            INF  20-50mcg/kg/minute

MAGNESIUM SULFATE (MgSO₄)

TRADE NAME: N/A

SUMMARY:

Magnesium sulfate acts as a CNS depressant and also depresses smooth, skeletal, and cardiac muscle functions. Magnesium sulfate reduces striated muscle contractions and blocks peripheral neuromuscular transmission by reducing acetylcholine release at the myoneural junction. In emergency care, magnesium sulfate is used in the management of seizures associated with toxemia of pregnancy.

 

Other uses of magnesium sulfate include uterine relaxation (to inhibit contractions of premature labor), bronchodilation after β agonist and anticholinergic agents have been used, replacement therapy for magnesium deficiency, as a cathartic to reduce the absorption of poisons from the GI tract, and in the initial therapy for eclamptic convulsions. Magnesium sulfate is gaining popularity as an initial treatment in the management of various dysrythmia, particularly torsades de pointes and dysrhythmias secondary to tricyclic antidepressant overdose or digitalis toxicity. The drug is also considered as a Class IIb agent for refractory ventricular fibrillation/ventricular tachycardia, after the administration of Lidocaine or Amiodarone doses.

 

PHARMACOLOGICAL ACTION(S):

A CNS depressant

A depressant of cardiac, skeletal, and smooth muscles

Possesses mild diuretic and vasodilating effects

 

SYSTEM INDICATION(S):

Asthma

Eclamptic Seizure or Prophylaxis of Eclamptic Seizure

Post-Infarct Hypomagnesemia

Torsades de Pointe/Polymorphic Ventricular Tachycardia (recurrent or refractory)

 

CONTRAINDICATION(S):

Anuria

A-V block

Hypermagnesemia

Hypocalcemia

 

PRECAUTION(S):

Any degree of renal insufficiency

Within 2 hours of delivery of fetus

MAGNESIUM SULFATE. (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Drowsiness
Resp	Decreased respiratory rate
CV	Dysrhythmias, Bradycardia, Hypotension
GI	Diarrhea
Derm	Flushing, Sweating
Metab	Hypothermia

 

ROUTE OF ADMINISTRATION

IM

IV

IV Infusion

 

RATE OF ADMINISTRATION:

Too rapid administration may cause hypotension, asystole or respiratory arrest

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	5-10 min	unknown	30 min

 

REVERSAL TREATMENT(S):

Antidote calcium chloride

Supportive measures.

 

DOSE:

Asthma

Adult:            INF 2g in 50ml over 2-10 minutes

            INF  1-4g/hr.

Pedi:            25-50mg/kg to max 2g in 50ml over 2-10 minutes

 

Eclampsia

Adult:            INF  2-4g in 50ml over 4 minutes to cessation of convulsion

            INF  1-4g/hr.

Pedi:            Not Indicated

 

Torsades

Adult:            IV 1-2 g push.

Pedi:            25-50mg/kg to max 2g push.

METHYLPREDNISOLONE

TRADE NAME: A-MethaPred, Prednisone, Solu-Medrol

SUMMARY:

Methylprednisolone is an intermediate-acting synthetic adrenal corticosteroid, with similar glucocorticoid activity but considerably fewer sodium and water retention effects than hydrocortisone.  It suppresses acute and chronic inflammation.  In addition, it potentiates vascular smooth muscle relaxation by beta-adrenergic agonists, and may alter airway hyperactivity.  A newer usage is for the reduction of post-traumatic spinal cord edema.

 

PHARMACOLOGICAL ACTION(S):

Adrenocortical steroid that suppresses inflammation & normal immune response

Numerous intense metabolic effects (see side effects)

 

SYSTEM INDICATION(S):

Asthma

Allergic Reaction

COPD/Airway Infection

OLMC Prevention of fat embolism in patients with a long bone fracture

 

 

CONTRAINDICATION(S):

Hypersensitivity to any product component (including sulfites)

Newborns

Systemic fungal infections

 

PRECAUTION(S):

Active or healed tuberculosis

Active or latent peptic ulcer disease

Acute psychoses

Chickenpox

Congestive heart failure

Diabetes Mellitus

Diverticulitis

Hypertension

Myasthenia gravis

Pregnancy

Psychotic tendencies

Renal insufficiency

Thromboembolic tendencies

METHYLPREDNISOLONE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

Adverse reactions/side effects are more common in high dose/long term therapy.

CNS	Depression, Euphoria, Headache, Increased intracranial pressure (pediatrics only), Personality change, Psychoses, Restlessness
EENT	Cataracts, Increased intraocular pressure
CV	Hypertension
GI	Anorexia, Nausea, Peptic ulceration, Vomiting
Derm	Decreased wound healing, ecchymosis, Petechiae
Endo	Adrenal suppression, Hyperglycemia
F&E	Fluid retention, Hypokalemia
Hemat	Thrombophlebitis
MS	Muscle pain, Muscle wasting
Misc	Increased susceptibility to infection

 

ROUTE OF ADMINISTRATION:

IM

IV

IV Infusion

 

RATE OF ADMINISTRATION:

Bolus: Each 500 mg (or fraction thereof) over 2-3 minutes or longer

Direct IV administration is usually the route of choice and eliminates the possibility of overloading the patient with IV fluids

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	< 1 min	unknown	unknown
IV	< 1 min	unknown	unknown

 

REVERSAL TREATMENT(S):

Supportive measures.

 

DOSE:

Adult:            IV  62.5-125mg over 1 minute.  Max 125mg

Pedi:            IV 1-2mg/kg over 1 minute.  Max 125mg

MIDAZOLAM HYDROCHLORIDE

TRADE NAME: Versed

SUMMARY:

Midazolam is a short-acting water-soluble benzodiazapine. It is a CNS depressant with muscle relaxant, anticonvulsant, and anterograde amnesic effects. Midazolam’s mechanism of action is unclear, except it is known to intensify the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter of the brain. It does this by interfering with the brain’s reuptake of GABA and promoting accumulation of GABA at neuronal synapses. This calms the patient, relaxes skeletal muscles, and in high doses produces sleep. Midazolam may be administered for conscious sedation to relieve apprehension or to impair memory prior to tracheal intubation or cardioversion.

 

PHARMACOLOGICAL ACTION(S):

Short acting benzodiazepine 3-4 times more potent than diazepam

Depressant effects are dependent on dose, route, and other medications

Effects mediated by gamma-aminobutyric acid (GABA)

 

SYSTEM INDICATION(S):

Cardioversion

Rapid Sequence Induction

Combative Patient Management

 

CONTRAINDICATION(S):

Hypersensitivity to midazolam (sensitivity to other benzodiazepines may exist)

Hypotension (except in case of convulsions)

 

PRECAUTION(S):

Glaucoma (acute narrow angle)

Lactation

Pregnancy

Acute alcohol intoxication with depressed vital signs

Congestive heart failure

Debilitated patients (more susceptible to depressant effects reduce dosages)

Geriatrics (more susceptible to depressant effects reduce dosages)

Pulmonary disease

Renal impairment

Severe hepatic impairment

MIDAZOLAM HYDROCHLORIDE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Agitation, Drowsiness, Excess sedation, Headache
EENT	Blurred vision
Resp	Apnea, Bronchospasm, Cough, Laryngospasm, Respiratory depression
CV	Dysrhythmias, Cardiac arrest, Hypotension
GI	Hiccoughs, Nausea, Vomiting
Derm	Rashes
Local	Pain at IM site, Phlebitis at IV site

 

 

ROUTE OF ADMINISTRATION:

IM

IV

 

RATE OF ADMINISTRATION:

Conscious sedation:

o Any single increment of a total dose titrated slowly over at least 2 minutes

o Stop at any point that the speech becomes slurred

Induction of anesthesia (RSI):

o Any single increment of a total dose over 20-30 seconds

o Rapid injection may cause respiratory depression or apnea

Pediatrics:

o Give slower than the adult rate

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	15 min	30-60 min	2-6 hr
IV	1.5-5 min	up to 5 min	2-6 hr

 

 

REVERSAL TREATMENT(S):

Antidote Flumazenil

Supportive measures

 

DOSE:

Pre Cardioversion Sedation

Adult:            IV  2.5-5mg if SBP >90

Pedi:            <0.1mg/kg if SBP >90

 

Rapid Sequence Induction, Initial Sedation

Adult:            IV  10-20mg if SBP>90

Pedi:            IV 0.2-0.3mg/kg if SBP >90

 

Rapid Sequence Induction, Ongoing Sedation

Adult:            IV  2.5-5mg, prn if SBP>90

Pedi:            IV  0.1mg/kg if SBP >90

 

Combative Patient Management

Adult:            IM 2.5-5mg

Pedi:            Not Indicated

MORPHINE SULFATE

TRADE NAME: Astramorph, Duramorph, MSIR, MS Contin, Oramorph, Roxanol

SUMMARY:

Morphine sulfate is a natural opium alkaloid that increases peripheral venous capacitance and decreases venous return. It promotes analgesia, euphoria, and respiratory and physical depression. Secondary pharmacological effects of morphine include depressed responsiveness of alpha-adrenergic receptors (producing peripheral vasodilation) and baroreceptor inhibition. In addition, morphine decreases both preload and afterload, thus it may decrease myocardial oxygen demand. The properties of this medication make it extremely useful in emergency care.  Morphine sulfate is a Schedule 2 drug.

 

PHARMACOLOGICAL ACTION(S):

Binds to opiate receptors in the CNS

Alters perception and response to pain

Produces generalized CNS depression

Relieves cardiogenic pulmonary congestion

Lowers myocardial oxygen demand

Reduces anxiety

 

SYSTEM INDICATION(S):

Moderate to severe, acute and chronic pain

Pain associated with cardiac event

Pulmonary edema (acute) associated with left ventricular failure

 

CONTRAINDICATION(S):

Bronchial asthma (acute)

Diarrhea caused by poisoning, until toxic material eliminated

Hypersensitivity to opiates

Premature infants

Labor and delivery of premature infants

Pulmonary edema caused by chemical respiratory irritant

Respiratory depression

Upper airway obstruction

 

PRECAUTION(S):

Adrenal insufficiency

Alcoholism

Head trauma

Hepatic disease

Hypothyroidism

Increased intracranial pressure

Labor (may cause respiratory depression in the newborn)

Pulmonary disease

Renal disease

Undiagnosed abdominal pain

MORPHINE SULFATE (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Confusion, Dizziness, Dysphoria, Euphoria, Floating feeling, Hallucinations, Headache, Sedation, Unusual dreams
EENT	Blurred vision, Diplopia, Miosis
Resp	Respiratory depression
CV	Bradycardia, Hypotension
GI	Constipation, Nausea, Vomiting
GU	Urinary retention
Derm	Flushing, Itching, Sweating

 

ROUTE OF ADMINISTRATION:

IM

IV

 

RATE OF ADMINISTRATION:

2 mg over 30 seconds-1 minute

Side effects markedly increase if the rate of administration is too rapid

 

TIME / ACTION PROFILE:

 

	ONSET	PEAK	DURATION
IM	10-30 min	30-60 min	4-5 hr
IV	< 1 min	20 min	4-5 hr

 

 

REVERSAL TREATMENT(S):

Antidote Naloxone

Supportive measures.

 

DOSE:

Moderate to severe pain

Adult:            2-10 mg q 5-15 minutes with SBP >90

Pedi:            IV up to 0.1mg/kg q 5-15 minutes with SBP >90

 

Pain associated with cardiac event

Adult:            2mg q 5-10 minutes to relief of pain

Pedi:            Not Indicated

 

Pulmonary edema (acute) associated with left ventricular failure

Adult:            IV  <2mg with SBP >90

Pedi:            Not Indicated

 

NALOXONE

TRADE NAME: Narcan

SUMMARY:

Naloxone is essentially a pure opiate antagonist, with little or no agonistic activity. The precise mechanism of action of the opiate antagonist effect of naloxone is not known. It is thought to act as a competitive antagonist at the opiate receptors in the CNS. It exerts little or no pharmacological effect on patients who have not recently received opiates. Even extremely high doses of the drug (10 times the therapeutic dose) produce only insignificant analgesia, only slight drowsiness, and no respiratory depression, psychomimetic effects, circulatory changes, or miosis.

 

In a patient who has received large doses of morphine or other analgesic drugs with morphine-like effects, naloxone antagonizes most of the effects of the opiate. They experience an increase in respiratory rate and minute volume, arterial PCO2 decreases toward normal value, and blood pressure returns to normal if depressed. Naloxone antagonizes mild respiratory depression caused by small doses of opiates. Because its duration of action is generally shorter than that of the opiate, the effects of the opiate return as the naloxone dissipates, possibly requiring additional doses. Naloxone antagonizes opiate-induced sedation or sleep. There are conflicting beliefs as to whether or not naloxone modifies opiate-induced excitement or seizures. Naloxone does not produce tolerance or physical or psychological dependence.

 

PHARMACOLOGICAL ACTION(S):

Reversal of CNS depression due to suspected opioid OD

Reversal of respiratory depression due to suspected opioid OD

Competitively blocks opiates, without producing agonist (opioid-like) effects

 

SYSTEM INDICATION(S):

Opioid OD (suspected)

Respiratory depression reversal

 

CONTRAINDICATION(S):

Hypersensitivity to the medication or any of its components

 

PRECAUTION(S):

Cardiovascular disease

Lactation

Neonates (of opioid dependent mothers)

Physically dependent patient on opioids (may precipitate severe withdrawal)

Pregnancy

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CV	Hypertension, Hypotension, Ventricular fibrillation, Ventricular tachycardia
GI	Nausea, Vomiting

 

ROUTE OF ADMINISTRATION:

IM

IV

NALOXONE (Cont’d)

RATE OF ADMINISTRATION:

Titrate to improved respiratory rate

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	1-2 min	unknown	45 min
IM	2-5 min	unknown	> 45 min
SQ	2-5 min	unknown	> 45 min

 

REVERSAL TREATMENT(S):

N/A

 

DOSE:

Adult:            IV up to 2mg titrated to respiratory effort.  Max cumulative dose 10mg.

Pedi:            IV up to 0.1mg/kg, max single dose 2mg.  Max cumulative dose 10mg.

NITROGLYCERIN

TRADE NAME: Deponit, Minitran, Nitro-Bid, Nitrocap, Nitrodisc, Nitro-Dur, Nitrogard, Nitroglyn, Nitrol, Nitrolingual, Nitrostat, Tridil

 

SUMMARY:

It was originally believed that nitrates and nitrites dilated coronary blood vessels, thereby increasing blood flow to the heart.  It is now believed that arteriosclerosis limits coronary dilation, and the benefits of nitrates and nitrites are due to dilation of the arterioles and veins in the periphery.  Nitroglycerin is very lipid soluble and is thought to enter the body from the GI tract through the lymphatics, rather than the portal circulation.

 

Nitroglycerin is an organic nitrate potent vasodilator with anti-anginal, anti-ischemic, and antihypertensive effects.  It relaxes vascular smooth muscle by an unknown mechanism, resulting in dose related dilation of both venous and arterial blood vessels. Nitroglycerin promotes peripheral pooling of blood, reduction of peripheral resistance, and decreased venous return to the heart.  Both left ventricular preload and afterload are reduced and myocardial oxygen consumption is decreased.  Therapeutic doses may reduce systolic, diastolic, and mean blood pressures, and the heart rate is usually slightly increased.

 

PHARMACOLOGICAL ACTION(S):

Vasodilator

 

SYSTEM INDICATION(S):

Angina pectoris (prophylaxis, treatment, and management)

Cardiac workload reduction in acute MI/Suspected Cardiac Event

CHF with pulmonary edema

Ischemic chest pain

 

CONTRAINDICATION(S):

Viagra (sildenafil) use within 24 hours

Cerebral hemorrhage

Constrictive pericarditis

Head trauma

Hypersensitivity

Hypotension

Pericardial tamponade

 

PRECAUTION(S):

Anemia (severe)

Hepatic disease

Hypovolemia (uncorrected)

Increased ICP

Renal disease

NITROGLYCERIN (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Apprehension, Blurred vision, Dizziness, Faintness, Headache, Vertigo, Weakness
CV	Circulatory collapse, Hypotension (postural), Increase in angina, Palpitations, Syncope, Tachycardia (some with paradoxical bradycardia)
GI	Abdominal pain, Dry mouth, Incontinence of feces and urine, Nausea, Vomiting
Hemat	Methemoglobinemia (high doses)
Other	Cold sweat, Local sensation in oral cavity at point of dissolution of drug, Muscle twitching, Pallor, Perspiration

 

ROUTE OF ADMINISTRATION:

SL

Transdermal

 

RATE OF ADMINISTRATION:

1 SL dose q 5 minutes

TD absorption is increased with sealing of edges of patch with tape

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
SL	2 min	unknown	30 min

 

REVERSAL TREATMENT(S):

Supportive measures.

Removal of TD patch and wiping off paste with dry gauze.

 

DOSE:

Adult:            TD  ½ to 1 inch (7.5-15mg) as long as SBP >100.

            SL  0.4mg q 5-10 minutes as long as SBP >100.

Pedi:            Not Indicated

OXYTOCIN

TRADE NAME: Pitocin, Syntocin

SUMMARY:

Oxytocin is a synthetic hormone named for the naturally occurring posterior pituitary hormone. By direct action on the myofibrils, it stimulates uterine smooth muscle contractions and helps expedite the normal contractions of spontaneous labor. As with all significant uterine contractions, there is a transient decrease in uterine blood flow. Uterine sensitivity to oxytocin increases during the gestation period and peaks sharply before parturition. Oxytocin also stimulates the mammary glands to increase lactation, without increasing the production of milk.  The drug is administered in the prehospital setting to control postpartum hemorrhage.

 

PHARMACOLOGICAL ACTION(S):

Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor.

Stimulates mammary gland smooth muscle facilitating lactation.

Vasopressor and antidiuretic effects

 

SYSTEM INDICATION(S):

Not used in MFAEMS

 

CONTRAINDICATION(S):

Anticipated non-vaginal delivery (e.g. Breech, Placenta previa, etc.)

Hypersensitivity

Placenta not delivered

Presence of additional fetus

 

PRECAUTION(S):

1st & 2nd stages of labor

Concomitant use with vasoconstrictive drugs

OXYTOCIN (Cont’d)

ADVERSE REACTION(S) & SIDE EFFECT(S):

Maternal

CNS	Anaphylaxis, Anxiety, Coma, Nausea, Seizures, Vomiting
CV	Dysrhythmias, EKG changes, Hypotension, Hypertension
F&E	Hypochloremia, Hyponatremia, Water retention
Misc	Abruptio placenta, Contractions (painful), Decreased uterine blood flow, Edema, Increased uterine motility, Tetanic contractions, Uterine rupture

Fetal

CNS	Intracranial hemorrhage
Resp	Asphyxia, Hypoxia
CV	Dysrhythmias, Bradycardia
Misc	Neonatal Jaundice, Death

 

ROUTE OF ADMINISTRATION:

IV (Preferred)

IM

Nasal

 

RATE OF ADMINISTRATION:

Rate of infusion must control uterine atony.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	3-5 min	unknown	30-60 min
IV	Immediate	unknown	1 hr
Nasal	few min	unknown	20 min

 

REVERSAL TREATMENT(S):

D/C infusion

Supportive measures

 

DOSE:

Adult:            Not Indicated

Pedi:            Not Indicated

PROMETHAZINE

TRADE NAME: Pentazine, Phenazine, Phencen, Phenergan, Prometh, Prorex, Prothazine, V-Gan

 

SUMMARY:

Promethazine is a phenothiazine derivative with potent sedative properties. Although the drug can produce either CNS stimulation or CNS depression, CNS depression manifested by sedation is more common with therapeutic doses of promethazine. The precise mechanism of the CNS effects of the drug is not known.  Promethazine also has antihistaminic, antiemetic, antimotion sickness, anticholinergic, and local anesthetic effects. Although it has been reported that the drug has slight antitussive activity, this may result from its anticholinergic and CNS depressant effects. In therapeutic doses, promethazine has no substantial effect on the cardiovascular system. Although rapid IV administration of promethazine may produce a transient fall in blood pressure, blood pressure is usually maintained or slightly elevated when the drug is given slowly. Promethazine is used for its sedative and antiemetic effects in surgery and obstetrics (during labor). The drug reduces preoperative tension and anxiety, facilitates sleep, and reduces postoperative nausea and vomiting. As a preanesthetic medication, promethazine is used in conjunction with reduced doses of an opiate analgesic and a belladonna alkaloid. Promethazine may also be used as a routine sedative and an adjunct to analgesics for control of pain.

 

PHARMACOLOGICAL ACTION(S):

Antiemetic action thought to be due to depression of CTZ in the medulla

Affects the central, autonomic, and peripheral nervous systems

Exerts antiserotonin, anticholinergic, and local anesthetic action like other antihistamines

Potent antihistaminic, antiemetic, antimotion sickness, sedative, and amnesic actions

Potentiates respiratory depressant, sedative and hypotensive effects of narcotics and other CNS depressants

Readily absorbed, primarily metabolized in the liver and excreted in the urine

Relatively free of extrapyramidal side effects seen with other phenothiazines

Relaxes smooth muscle

 

SYSTEM INDICATION(S):

Potentiate Effects of Morphine

Treatment of acute nausea, vomiting, and motion sickness

 

CONTRAINDICATION(S):

Bone marrow depression

Comatose or severely depressed states

Hypersensitivity to phenothiazines

Jaundice

Lactation

Never inject into an artery

Reye’s syndrome

Vomiting due to GI irritant (GI blood)

PROMETHAZINE (Cont’d)

PRECAUTION(S):

Pregnancy

Asthma

Cardiovascular disease

Hepatic disease

Respiratory impairment (particularly in pediatrics) acute or chronic

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

Toxicity is characterized by abnormal movements, Cardiorespiratory symptoms, CNS stimulation, Coma, Convulsions, Deep sleep, Extrapyramidal reactions, Nightmares (pediatrics), respiratory depression

CNS	Confusion, Disturbed coordination, Dizziness, Drowsiness, Restlessness, Sedation, Tremors
CV	Transient mild hypertension or hypotension
GI	Anorexia, Constipation, Nausea, Vomiting
Hemat	Agranulocytosis, Leukopenia
Other	Blurred vision, Dry mouth, Dry nose, Dry throat, Irregular respiration, Photosensitivity, Urinary retention

 

ROUTE OF ADMINISTRATION:

IM

IV

 

RATE OF ADMINISTRATION:

Slow IV push, diluted to 25mg in 10ml, if possible, to avoid discomfort associated with administration.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IM	< 20 min	unknown	2-8 hr
IV	1-5 min	unknown	4-6 hr

 

REVERSAL TREATMENT(S):

Supportive measures

Benadryl to reverse extrapyramidal effects.

 

DOSE:

Adult:            6.25-12.5mg q 5-15 minutes with SBP >90 to max total dose of 25mg.

Pedi:            0.25-0.5mg/kg with SBP >[70 + (2 x age)].

 

 

Rocuronium Bromide

TRADE NAME: Zemuron

SUMMARY: 

Used as an adjunct to general anesthesia to facilitate rapid sequence and routine tracheal intubation; also, to cause relaxation of skeletal muscle during surgery or mechanical ventilation. Use must be accompanied by adequate anesthesia or sedation, as the drug has no effect on consciousness, pain threshold, or cerebration. Depending on the dose, it has a rapid to intermediate onset and an intermediate duration of action.

 

PHARMACOLOGICAL ACTION(S): 

A non-depolarizing neuromuscular blocking agent that acts by competing with acetylcholine for receptors at the motor end-plate. Causes histamine release in a small percentage of patients.

 

SYSTEM INDICATION(S):

Used after induction of anesthesia and short-acting paralytics to sustain skeletal muscle paralysis during rapid sequence induction.

 

CONTRAINDICATION(S):

 

PRECAUTION(S):

·         Pulmonary hypertension, valvular heart disease, or significant hepatic disease

·         Elderly clients may exhibit a slightly prolonged medical clinical duration of action.

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CNS	Skeletal muscle paralysis
CV	Arrhythmias, abnormal ECG, transient hypotension and hypertension, tachycardia.
GI	N&V.
INT	Rash, edema at injection site, pruritus
RESP	Bronchospasm wheezing, rhonchi; hiccup

 

NOTE  Use of the following will result in prolonged neuromuscular blockade:  Magnesium sulfate, tetracyclines, lithium, aminoglycoside antibiotics.

 

DOSE:

0.6-1.2 mg/kg in appropriately pre-medicated and adequately anesthetized clients will result in good intubation conditions in less than 2 min

 

ROUTE OF ADMINISTRATION:

IV

 

RATE OF ADMINISTRATION:

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	<2 minutes;	2 minutes;	30 minutes

 

REVERSAL TREATMENT(S):

Symptomatic and supportive therapies

 

DOSE:

Adult:            1mg/kg q 30 minutes

Pedi:            1mg/kg q 30 minutes

SODIUM BICARBONATE (NaHCO₃)

TRADE NAME: NaHCO₃

SUMMARY:

Sodium bicarbonate reacts with hydrogen ions to form water and carbon dioxide and thereby can act to buffer metabolic acidosis. By increasing the plasma concentration of bicarbonate, blood pH rises.

 

PHARMACOLOGICAL ACTION(S):

Buffer

 

SYSTEM INDICATION(S):

Known pre-existing metabolic acidosis

Tricyclic antidepressant overdose

Alkalinization for treatment of specific intoxications

Hyperkalemia

 

CONTRAINDICATION(S):

Benzodiazepine OD

Hypocalcemia

Hypochloremia secondary to emesis and GI suctioning

Hypokalemia

Metabolic alkalosis

Respiratory alkalosis

 

PRECAUTION(S):

Geriatrics

Pediatrics

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CV	Edema
GI	Flatulence, Gastric distention
F&E	Metabolic alkalosis, Hypernatremia, Hypocalcemia, Hypokalemia, Sodium retention, Water retention
Local	Irritation and tissue sloughing at injection site
Neuro	Seizures, Tetany
Resp	Increased intracellular PCO2 , Increased tissue acidosis

 

ROUTE OF ADMINISTRATION:

IV

 

RATE OF ADMINISTRATION:

Slow IV push

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	1-5 min	variable	variable

 

REVERSAL TREATMENT(S):

Supportive measures.

 

DOSE:

Adult:            1 mEq/kg

Pedi:            1 mEq/kg

SUCCINYLCHOLINE CHLORIDE

TRADE NAME: Anectine, Quelicin, Sucostrin

SUMMARY:

An ultra-short-acting depolarizing skeletal muscle relaxant. Causes paralysis by interfering with neural transmission at the myoneural junction. Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Has agonist activity initially, producing fasciculation. Causes the release of histamines. Has no analgesic or anxiolytic effects.

 

PHARMACOLOGICAL ACTION(S):

Skeletal muscle paralysis

 

SYSTEM INDICATION(S):

Post anesthesia skeletal muscle paralysis.

 

CONTRAINDICATION(S):

Known hyperkalemic state

Suspected hyperkalemia secondary to new onset paralysis (>24 hours), burns >20%, or renal failure.

Increased ICP (closed head injury) or IOP (glaucoma), or penetrating eye trauma.

Hypersensitivity to succinylcholine or parabens

History of malignant hyperthermia

Patients < 2 y/o

 

PRECAUTION(S):

History of pulmonary disease, renal or liver impairment

Myasthenia gravis or myasthenic syndromes

 

ADVERSE REACTION(S) & SIDE EFFECT(S):

CV	Hypotension, arrhythmias, bradycardia
F&E	Hyperkalemia
MS	Muscle fasciculation
Resp	Bronchospasm, apnea
Other	Malignant hyperthermia, myoglobinemia

 

ROUTE OF ADMINISTRATION:

IV

 

RATE OF ADMINISTRATION:

IV push. Too-rapid an administration rate may cause profound bradycardia
and, rarely, asystole.

 

TIME / ACTION PROFILE:

	ONSET	PEAK	DURATION
IV	0.5 - 1 min	1 2 min	4 10 min

 

REVERSAL TREATMENT(S):

Supportive measures

 

DOSE:

Adult:            2mg/kg.  May repeat once, prn.

Pedi:            2mg/kg.  May repeat once, prn.